Discuss Differential Diagnosis of Syphilis and Herpes Simplex Virus (HSV)

Discuss Differential Diagnosis of Syphilis and Herpes Simplex Virus (HSV)
Case 2

Differential Diagnosis

Secondary Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the Treponema pallidum bacterium (Fantasia, 2017). If untreated, this infection can lead to severe systemic diseases and or death (Fantasia, 2017). Syphilis can present in different stages such as primary, secondary, tertiary, early latent, and late latent. Characterizations of primary syphilis are lesion or chancre that begins with a painless papule at the inoculation site (Fantasia, 2017). The lesion then progresses to a non-tender, shallow, indurated, clean ulcer (Fantasia, 2017). The chancre is most commonly found on the genitalia (Fantasia, 2017). The portrayal of secondary syphilis incorporates a wide-spread, symmetrical maculopapular rash of the palms of hands and bottom of feet and lymphadenopathy (Fantasia, 2017). Condylomata lata may also develop. Symptoms of secondary syphilis may include fever, malaise, anorexia, weight loss, headache and myalgias (Fantasia, 2017). Cardiac, neurologic, ophthalmic, auditory, or gummatous lesions can develop in the tertiary stage (Tharpe, Farley, & Jordan, 2017). Characterizations of the latent phase include a positive test with no clinical appearances (Tharpe et al., 2017). Differential Diagnosis Essay – Syphilis and Herpes Simplex Virus (HSV)


Herpes Simplex Virus (HSV)

Genital herpes is painful vesicular eruptions of the skin and mucosa of the genitals (Fantasia, 2017). This infection is a recurrent and incurable viral infection (Fantasia, 2017). HSV-1 and HSV-2 strains can both cause genital herpes. Although, HSV-2 typically is more commonly associated with genital lesions and are sexually transmitted (Fantasia, 2017). Herpes can cause mucoid vaginal discharge, burning, and itching (Dains, Baumann, & Scheibel, 2016). Vesicles are grouped on a red base and erode into an ulcer (Dains et al., 2016). Exudates form on mucous membranes (Dains et al., 2016). Crusts form on the skin (Dains et al., 2016). Redness, edema, and tenderness to inguinal lymph nodes can also occur (Dains et al., 2016).

Human Papillomavirus (HPV)

Genital Warts result from sexual transmission of the HPV. They typically involve the vagina, cervix, perineum, or perianal areas (Dains et al., 2016). Lesions can be flat or raised moist pink verrucous lesions (Dains et al., 2016). Itching and leukorrhea can accompany clinical manifestations (Dains et al., 2016).

Most Likely Differential

The most likely diagnosis for the patient in case two is secondary syphilis. She had a non-tender sore on her labia that resolved with no treatment. The syphilitic chancre begins with a painless papule and evolves into a non-tender ulcer. The lesion can heal in 3-6 weeks without treatment (Dains et al., 2016). This process occurs in the primary stage of syphilis. A rash can develop during the healing stage of the primary lesion or weeks after it has healed. This patient had a normal gynecologic exam but has maculopapular lesions to her trunk, neck, palms, and soles of her feet. The portrayal of secondary syphilis incorporates a wide-spread, symmetrical maculopapular rash of the palms of hands and bottom of feet (Fantasia, 2017). Differential Diagnosis Essay – Syphilis and Herpes Simplex Virus (HSV)

Treatment and Management

Penicillin G is the drug of choice for all stages of syphilis (Pastuszczak & Wojas-Pelc, 2013). Secondary syphilis requires a single dose (Fantasia, 2017). Those with secondary syphilis will also require serologic testing at six and 12 months (Fantasia, 2017). Partner management depends on the stage of the woman’s infections and timing of exposure (Fantasia, 2017). Studies show that up to 60% of sexual contacts of patients with syphilis may be infected (Pastuszczak & Wojas-Pelc, 2013). If exposure to secondary syphilis is less than 90 days, the partner should receive treatment regardless of test results (Pastuszczak & Wojas-Pelc, 2013). Treatment is as follows:

Penicillin G Benzathine 2.4 milliunits IM x one dose.

Strategies for Educating Patients

First, it is essential to educate the patient on syphilis and the consequences of going without treatment. It is also vital to discuss preventions of new infections, reinfection, and risks for infecting others. Educate patient on the importance of partner notification. In Texas, Partner Services maintains confidential partner notification. If chancre is present, the patient must refrain from sexual contact with others. Inform patient that they must use a condom until testing at six months follow-up (Fantasia, 2017). The risk for acquiring HIV through sexual intercourse is three to five times higher in those infected with syphilis (Mutagoma et al., 2016). Therefore it is crucial for providers to stress HIV testing (Fantasia, 2017).


Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Fantasia, H.C. (2017). Sexually Transmitted Infections. In Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). (pp. 465-508). Burlington, MA: Jones and Bartlett Publishers.

Mutagoma, M., Remera, E., Sebuhoro, D., Kanters, S., Riedel, D. J., & Nsanzimana, S. (2016). The Prevalence of Syphilis Infection and Its Associated Factors in the General Population of Rwanda: A National Household-Based Survey. Journal of Sexually Transmitted Diseases, 2016, 4980417. http://doi.org/10.1155/2016/4980417

Pastuszczak, M., & Wojas-Pelc, A. (2013). Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii, 30(4), 203–210. http://doi.org/10.5114/pdia.2013.37029

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

Pastuszczak & Wojas-Pelc, 2013 Differential Diagnosis Essay – Syphilis and Herpes Simplex Virus (HSV)

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